Eosinophilic Pneumonia

Eosinophilic pneumonia (EP) is inflammation in your lungs caused by the buildup of eosinophils. Eosinophils are a type of white blood cell. They help your body fight certain types of infections. But too many can start to cause damage. This can make it hard to breathe and cause other respiratory symptoms.

Eosinophilic pneumonia is a form of interstitial lung disease. Types include:

• Acute (AEP): This type develops quickly, over a few days to two weeks. It can worsen quickly if you can’t get oxygen from your lungs to your blood.
• Chronic (CEP): This type worsens slowly, over weeks to months. If untreated, it can last months and eventually lead to chronic symptoms. These may be severe.

Go to the emergency room if you have symptoms like severe shortness of breath or chest pain. Pneumonia can become life-threatening quickly.

Symptoms of eosinophilic pneumonia

Symptoms can vary depending on the type. They include:

• Cough
• Fever
• Shortness of breath
• Tiredness
• Night sweats
• Wheezing
• Unexplained weight loss in CEP
• Chest pain and muscle aches in AEP

Symptoms of chronic eosinophilic pneumonia come on slowly and worsen over weeks or months. Acute eosinophilic pneumonia can worsen quickly. Call 911 (or your local emergency service number) or go to the ER if you have symptoms of pneumonia, especially if they’re getting worse.

Eosinophilic pneumonia causes

Causes of eosinophilic pneumonia depend on the type. Causes of AEP can include:

• Inhaled toxins, including dusts, smoke from fires, chemical fumes or metal dusts
• Cigarette smoking, especially if you go back to smoking after previously quitting, or smoking more often
• Vaping/electronic cigarette use
• Medications, including certain antibiotics, nonsteroidal anti-inflammatory medications and some antidepressants and anti-seizure medications
• Certain infections in your lungs

Providers often don’t know the cause of CEP. But causes can include:

• Medications — the same medications that can cause AEP can also cause CEP
• Parasite infections in your lungs
• Fungal allergy if you have asthma or cystic fibrosis
• Radiation treatment to your chest

Risk factors

Your risk of developing eosinophilic pneumonia depends on the type. AEP is more common in:

• Males between ages 20 and 40
• People who currently smoke

CEP is more common in:

• Females between ages 30 and 50
• People who have allergic conditions, including asthma, eczema (atopic dermatitis) and allergic rhinitis (hay fever)

Most people with CEP don’t smoke.

Complications

If left untreated, AEP can lead to respiratory failure, when your body can’t properly bring in oxygen or get rid of carbon dioxide. CEP doesn’t usually cause respiratory failure. But over time, it can cause permanent lung scarring.

How doctors diagnose eosinophilic pneumonia

It can take a number of tests to diagnose eosinophilic pneumonia. Depending on your symptoms, your healthcare provider may start with common tests and imaging, including:

• Chest X-ray
• CT scan
• Blood tests
• Lung function tests

Your provider may recommend bronchoalveolar lavage (BAL) to diagnose eosinophilic pneumonia. In this procedure, a provider uses a flexible tube (bronchoscope) to collect fluid from your lungs. The fluid is sent to a lab to look for signs of disease and its causes.

You may need additional tests depending on the cause.

How is eosinophilic pneumonia treated?

Corticosteroids are very effective in treating both acute and chronic eosinophilic pneumonia. If you’re very sick and being treated in the hospital, you may also need supplemental oxygen or other treatments.

If you have CEP, your provider might recommend ongoing treatment with biologic medications instead of steroids. These could include mepolizumab (Nucala®), benralizumab (Fasenra®), omalizumab (Xolair®) or duplumab (Dupixant®).

You may also need to address anything that caused the condition. This could include:

• Stopping smoking or vaping
• Stopping or changing medications
• Protecting yourself from things you inhale that could be harmful
• Managing underlying health conditions

Recovery time

Recovery from eosinophilic pneumonia depends on the type and severity. Many people with acute eosinophilic pneumonia recover quickly, sometimes within 48 hours after steroid treatment. Most people take one to two weeks to fully heal.

If you have chronic eosinophilic pneumonia, you’ll likely need to take medications for many months or longer.

When should I see my healthcare provider?

Go to the ER if you have severe shortness of breath or chest pain, especially if you have a fever or your symptoms get worse quickly. These can be signs of many serious conditions.

See a healthcare provider if you have symptoms like cough and shortness of breath that get worse over time, unexplained weight loss or other symptoms of CEP.

What can I expect if I have eosinophilic pneumonia?

With quick treatment, you’re most likely to make a complete recovery from eosinophilic pneumonia.

If you have chronic EP, your healthcare provider will work with you to manage it and ease your symptoms. Many people with CEP recover with corticosteroids, but experience relapses that need to further treatment.

Can eosinophilic pneumonia be prevented?

Some steps you can take to reduce your risk of eosinophilic pneumonia include:

• Don’t smoke or vape.
• Take precautions to avoid infections, like washing your hands and getting recommended vaccines.
• Avoid harmful substances, like asbestos, metal dusts or chemicals. Wear a respirator (a mask that filters particles from the air) if you must be around them.
• Work with your provider to manage health conditions that affect your lungs or cause inflammation.